Cruel, But Not Unusual

State prisoners say lousy medical care is killing them

Caroline Isaacs: "There are really serious consequences to this type of incompetence. But prisoners are people that nobody cares about."

A narrow road shadows the outer fence at Arizona's state prison in Tucson. Composed of light gravel, always raked smooth, the lane is a blank palette for the footprints of escape. Yet much of this complex holds only petty offenders—short-termers, really—for whom such capers would seem pointless.

But it seems even they can face a death sentence of sorts, delivered by a culture of medical neglect.

That's why two top dogs at the Arizona Department of Corrections are currently being sued, not only by the American Civil Liberties Union of Arizona, but also by the potent, San Quentin, Calif.-based Prison Law Office. In 2011, Prison Law scored a resounding U.S. Supreme Court victory that compelled California to reduce prison overcrowding.

The Arizona lawsuit was filed in March against Corrections Director Charles Ryan and his health services director, Richard Pratt. It alleges that "medical, mental health, and dental care" provided to inmates is "grossly inadequate and subjects all prisoners to a substantial risk of serious harm, including unnecessary pain and suffering, preventable injury, amputation, disfigurement and death...

"Critically ill prisoners," the lawsuit continues, "have begged prison officials for treatment, only to be told 'be patient,' 'it's all in your head,' or 'pray' to be cured."

Dan Pochoda is legal director for the ACLU of Arizona. He calls health care in our state prisons "the worst I've ever seen, in terms of clearly increasing harm unnecessarily because of the inadequate care, and the absence of anything except trying to save money on the backs of the prisoners."

Because of its sweeping implications, the case has since evolved into a class action lawsuit. The next step is proving in court just how dire the situation truly is, says Pochoda. "The ideal outcome would be a finding that there is clearly deliberate indifference to the serious medical and mental health needs of the inmate population, that people are dying unnecessarily, that folks who are in for sentences of a few years—not life sentences or death sentences—are coming out with permanent and serious illnesses."

Their ranks include Robert Plasa, now doing three years at the Tucson prison for violating his probation. Back in 2011, before he was sent to jail, Plasa says he was diagnosed with thyroid cancer. He was waiting to have the gland removed when he was arrested.

Today, he's still waiting. "I have been strung along for almost a year-and-a-half here without treatment," he wrote me in a letter this March.

In that time, Corrections has turned its state-run prison medical program over to one private health care provider, and then to another. But for Plasa, apparently little has changed—except that his diagnosis has grown even more grim. "I have recently had blood work done and ultrasound on the thyroid," he wrote. "This revealed that the cancer not only spread through the whole thyroid, it is now in the lymph nodes. The thyroid could have been cut out before, and isolated the cancer. Due to the lack of medical attention and negligence on the part of the Department of Corrections, I have a more serious and maybe life-threatening medical condition."

When I asked Corrections for details on Plasa's plight, spokesman Andrew Wilder referred me to the state's current prison health care provider, Corizon Inc. of Brentwood, Tenn. Citing privacy laws, Corizon also refused to comment on Plasa. But in an email, company spokesman Brian Fulton did issue this boilerplate response: "We can say that since Corizon assumed providing medical services for the Arizona Department of Corrections in March 2013, our caregivers have worked hard every day to provide quality health care services that meet and exceed national accreditation standards."

To Caroline Isaacs, however, Plasa's version sounds much closer to the truth. She heads the American Friends Service Committee's Tucson office, which has long agitated for Arizona prison reforms. "This guy's problem is not an isolated issue," Isaacs says. "There are really serious consequences to this type of incompetence. But prisoners are people that nobody cares about."

Indeed, the ACLU's Pochoda provided a stream of examples in which prison medical care was seemingly riddled with negligence. They include the inmate displaying chronic and mysterious flu symptoms that were never treated. Or the prisoner with a growth on his throat that was left untreated until it burst. Following surgery, his condition was again ignored until it worsened. Only then did the doctors decide that the growth was cancerous; the man has yet to receive standard treatment such as radiation.

Then there's the guy who did have his cancerous prostate removed, but then received no follow-up testing to ensure that the cancer had not returned. Only much later—too much later, it appears—did he receive tests showing that the cancer had not only rebounded, but was now spreading.

In response to their panicky letters, distressed relatives or partners of inmates received cavalier responses from Corizon—at least when they weren't outright ignored. "Please be assured that (your boyfriend) is not going to die," a Corizon apparatchik finally wrote to one worried woman, after she repeatedly tried to get information. "It is important to remember that (the inmate) is an adult and must take some part in his day to day health care."

This current wave of incompetence dates to 2011, when the Legislature directed Corrections to put its health services out to bid. Last summer, a three-year, $349 million contract was awarded to Pittsburgh-based Wexford Health Sources despite the company's troubled history in other states. True to form, Wexford's Arizona tenure soon hit turbulence when Corrections blamed it for poor record keeping and staffing problems. In less than a year, prison medical care had switched over to Corizon.

But for critics such as Pochoda, that's like choosing which train to ride off the rails. "Wexford has a very spotty record, after getting kicked out of other states, and it was a disaster," he says. "After nine months, they got fired or quit, and now (Corrections) has brought in Corizon, also with a spotty record. And we don't believe it will make a bit of difference because the goal is to reduce costs. For the private firms, there's a profit motive: the less they spend, the more they keep."

Ultimately, he blames state lawmakers for privatizing prison health care to save a buck, "but not uttering a peep about how it should be a better service, and not result in so many deaths, etc."

That's hardly news for guys like Robert Plasa.

"I have a good company I work for and a beautiful family waiting for me," Plasa wrote in his letter. "I wasn't figuring that paying my dues to the state of Arizona meant a life sentence from cancer."